Your Digest for Monday, Mar 11, 2024 07:59 PM


[!TIP] Info: If a patient has Addison's disease, evaluate for the presence of primary cause for Addison's OR presence of APS (Autoimmune polyglandular disease)

[!TIP] mnemonic for causes of hypoadrenalism
Infection
Infiltration
Immune(autoimmune)
infarction
inherited (adrenoleukodystrophy)
iatrogenic


GVHD arises when immune cells transplanted from a non-identical donor graft into the recipient (host), recognize the host cells as "foreign," thereby initiate a graft-versus-host reaction.

"Successful transplantation requires that the donor immune system develop tolerance to these alloantigens, while maintaining the ability to recognize and respond to foreign antigens, such as microorganisms or tumor cells."

GVHD is responsible for upto 50% of post transplant mortality.
Management of GVHD:
All patients receiving haematopoietic stem cell transplant are given prophylaxis with cyclorporine and methotrexate.
If GVHD develops, mainstay of treatment is with steroids.
Source

Transfusion associated graft Vs. host disease


BacterialpathogensMnemonic.jpg
"There are five medically important genera of gram-positive rods: Bacillus, Clostridium, Corynebacterium, Listeria, and Gardnerella."

Bacterial spore formation


mesangialIgAStaining.png
mesangialDepositsInIgAnephropathy.png
D - mesangial deposits
2. It causes recurring episodes of microscopic or gross haematuria lasting a few days. Usually recurs every few months after the onset. Can present as microscopic haematuria as well.
1. in PSGN, the haematuria develops 1-2 weeks after the respiratory infection.
6. Hallmark is IgA deposition in the mesangium. (Mesangial deposist are granular deposits)
10. Progression to CKD is slow (if at all - occurs in about 40 of cases)
1. If CKD occurs, the treatment is kidney transplant, BUT recurrent IgA deposition in the allograft is common.
6. Apparently presence of macroscopic haematuria is a good prognostic factor because patients present earlier.
Summary: ACEi / ARB -> SGLT-2 inhibitor -> Steroid as last line with poor resolution


Type 2 Type 1 Type 4
❗Very rare❗ Most common type
Aldosterone resistance of CD
Sjogren Diabetic nephropathy
Fanconi Syndrome Rheumatoid Arhtitis Chronic interstitial nephritis
Light chain nephropathy Cirrhosis ACEi use, Heparain and enoxa,NSAIDS
i.e 👆🏼Myeloma Sickle cell anaemia K+ sparing diuretics
Acetazolamide, Topiramate Kidney transplant CAH, primary adrenal insufficiency
Wilson's disease Amphotericin B, lithium
Secondary hyperparathyroidism
Heavy metals

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McArdle's disease

#autosomal-Recessive